Abdominal aortic aneurysm

Question 1

Definition of an aneurysm?

Answer 1

Abnormal focal dilatation of an endothelial-lined vascular structure (artery, vein, heart chamber)

Question 2

Commonest site for an aneurysm requiring treatment?

Answer 2

Infrarenal aorta

Question 3

Risk factors for AAA? (6)

Answer 3

Family history
Smoking
Hypertension
Hyperlipidaemia
Male sex
Increasing age

Question 4

In what three ways can AAA present?

Answer 4

Unruptured and asymptomatic (most common)
Unruptured and symptomatic
Ruptured

Question 5

How are asymptomatic AAAs found?

Answer 5

Incidental finding on clinical examination or scans (MRI, CT, ultrasound) conducted for another reason

Question 6

Symptoms of unruptured AAA? (3)

Answer 6

Pain in the central abdomen, back, loin, iliac fossa or groin
Distal embolisation causing limb ischaemia
Compression of uretur/inferior vena cava

Question 7

Presentation of ruptured AAA?

Answer 7

Sudden, severe abdominal pain

Syncope/shock/collapse

Question 8

What is the diameter cut-off for consideration of surgery?

Answer 8

5.5.cm

Question 9

Medical management of aneurysm? (4)

Answer 9

Smoking cessation
Blood pressure control
Statins
Anti-platelet therapy

Question 10

Investigation of AAA? (3)

Answer 10

Ultrasound
CT- provides more anatomical details
MR angiography

Question 11

What may the crescent sign on CT predict?

Answer 11

Imminent rupture

Question 12

Surgical options for AAA repair? (2)

Answer 12

Open aneurysm repair

EVAR

Question 13

Why should patients with ruptured AAA not undergo aggressive fluid resus?

Answer 13

Contraction in the circulating volume aids haemostasis (permissive hypotension)